Shareholder Name:
Shareholder Number:
Farmlands Contact Person
(If known)
Your Local Farmlands Branch:
(If known)
Address
Postal Address:
Farm Location:
Contact Details
Home phone:
Business:
Mobile:
Email:
Enquiry Type
Enquiry Type
New System
Addition
Dairy
Dry Stock
Stock Numbers:
Now
Future:
Property Size
(or area to be reticulated)
Water Source
Power Source
Farm map available?
Yes
No
Any existing pipework/tanks
to be used?
Yes
No
Please briefly explain what types of pipework/tanks are to be used:
Development timeline:
Additional Information:
Contact Information